Spandorfer J M, Karras D J, Hughes L A, Caputo C
Department of Internal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
Ann Emerg Med. 1995 Jan;25(1):71-4. doi: 10.1016/s0196-0644(95)70358-6.
To assess patients' comprehension of their emergency department discharge instructions and to determine if inner-city patients' literacy levels are adequate to comprehend written discharge instructions.
Prospective, observational study.
The ED of an inner-city university hospital.
Two hundred seventeen patients consecutively discharged from the ED during 12 separate time slots.
Patients were interviewed after discharge from the ED and asked to state their diagnosis, medication instructions, and follow-up instructions. Comparisons between patient recall and instructions as written in the chart were assessed by independent raters and scored from poor to excellent. Patients were administered a standardized test of reading ability.
Overall comprehension rates were judged to be good, although 23% of patients exhibited no understanding of at least one component of their discharge instructions. Mean reading ability of the patients was at the sixth-grade level. The ED's printed discharge instructions were written at an 11th-grade reading level. Patients with low literacy scores were more likely to have poor comprehension of instructions.
Overall comprehension rates in this population were good despite the fact that ED instruction sheets were written at an inappropriately high reading level. Verbal instructions given by the discharging physician likely have a significant effect on patients' comprehension of instructions.
评估患者对急诊科出院指导的理解程度，并确定市中心区患者的识字水平是否足以理解书面出院指导。
前瞻性观察研究。
市中心区一所大学医院的急诊科。
在12个不同时间段内从急诊科连续出院的217名患者。
患者从急诊科出院后接受访谈，被要求说出自己的诊断、用药指导和随访指导。由独立评估人员对患者回忆内容与病历中书面指导进行比较，并从差到优进行评分。对患者进行标准化阅读能力测试。
总体理解率被判定为良好，尽管23%的患者对其出院指导的至少一个部分不理解。患者的平均阅读能力为六年级水平。急诊科的打印出院指导是按照十一年级的阅读水平编写的。识字分数低的患者更有可能对指导理解不佳。
尽管急诊科指导手册的编写阅读水平过高，但该人群的总体理解率良好。出院医生给予的口头指导可能对患者对指导的理解有显著影响。
